FELLOWSHIP IN PAEDIATRIC NEPHROLOGY

Philosophy
Kidney diseases in children is a public health problem world-wide. There is a lot of
progress made in pediatric nephrology in developed countries, but children in Sub-
Saharan countries still suffer from high morbidity and mortality from acute and chronic
renal disease due to lack of qualified personnel and resources. Prevalence of chronic
kidney disease (CKD) is estimated to be about 10 - 12% in tropical African countries,
and children comprise a significant proportion of this disease burden. CKD is associated
with premature mortality, decreased quality of life and increased health care
expenditure. There is evidence that early involvement of a nephrologist in the
recognition and management of renal disease in children improves their outcomes
significantly, reducing morbidity and mortality.

 Rationale
Facilities and human resource required for specialized care of patients with kidney
diseases are still limited in the East African region. There are about 40 trained
nephrologists in the region, serving a population of about 145 million people of whom
> 50% are aged below 15 years. Thirty-one of these nephrologists live in Kenya and
are concentrated in major towns and cities. Expertise in paediatric nephrology is even
more limited, the region has only 8 paediatric nephrologists (6 are in Kenya) to serve >
70 million children, giving a ratio of nephrologists to children far below the WHO
desirable of 1 per 200,000 population.
The Kenyan Government has committed to provide specialized renal care services at
all the 47 administrative counties in the country. There is currently no sub-specialist
training course in paediatric nephrology within Eastern and Central Africa, and
paediatricians can only sub-specialise by training abroad, which is expensive and
difficult to access.
Stakeholder consultation with Medical licensing bodies, the health delivery sector
(public and private), and Paediatric Professional Associations provided valuable input
in the development of a sub-specialty fellowship program adapted to regional need.
Providing local opportunity for clinical fellowship sub-specialty training in paediatric
nephrology will address the urgent need for an increase in capacity building at county
and regional level for renal service provision. This is in line with the Constitution of
Kenya, 2010 Article 43 (1) (a), and in tandem with the Social Pillar (Pillar 2) of the
Kenya Vision 2030 with the objective of improving the overall livelihood of Kenyans
by providing an efficient and high quality healthcare system with the best of standards.
This goal is also envisaged in Goal 3 of the United Nations Sustainable Development
Goals (SDG).
It is with this background that the University of Nairobi in conjunction with the
Ministry of Health, Kenya, has established the East African Kidney Institute (EAKI) as
a Regional Centre of Excellence for kidney disease with supportive funding by the
Africa Development Bank (ADB). The EAKI is based at the College of Health Sciences
University of Nairobi within the Kenyatta National Hospital complex. This centre will
have capacity and facilities to train nephrologists and urologists for the Eastern African
region and beyond.

Goal
The Fellowship in Pediatric Nephrology is a Clinical Fellowship Degree Program
intended to provide paediatricians with world class highly specialized clinical training
of international standard. The course shall equip them with advanced knowledge and
specialized clinical skills in the evaluation and management of paediatric and
adolescent renal disease, as well as leadership and management capabilities in the
design and delivery of paediatric and adolescent renal services.

Expected Learning Outcomes
By the end of the clinical fellowship degree, the fellow should be able to:
a) Apply advanced knowledge and specialized skill in the evaluation, diagnosis and
comprehensive management of renal diseases in children and adolescents.
b) Demonstrate clear understanding of the design, organization, implementation,
monitoring and evaluation of health units that provide care for children and adolescents
with renal disease.
c) Analyze and utilize emerging evidence and available resources to address and advocate
for quality care for children and adolescents with renal conditions, taking note of local
priorities to inform policy.
d) Design and implement research in the field of paediatric nephrology.
e) Provide leadership, mentorship and continuing education to the health professionals
involved in delivery of care to children and adolescents with renal conditions.

 Core Clinical Competencies
Paediatric Nephrology Fellow will acquire competency in all areas of the paediatric
nephrology sub-speciality curriculum, including

1. Investigation of the renal system (Renal biopsies, Interpretation of renal functiontests, Interpretation of imaging studies among others)
2.  Care of children with various kidney disease;

o congenital anomalies of the renal tract,
o nephrotic syndrome,
o glomerulonephritis,
o vasculitis,
o inherited and acquired forms of tubulopathy,
o urinary tract infection and vesicoureteric reflux,
o renal stone disease,
o Inborn errors of metabolism and inherited nephropathies.

    3. Management of Acute Kidney Injury (peritoneal dialysis, haemodialysis and
        continuous venovenous haemodialysis/filtration)

    4. Management of Chronic Renal Failure (pre-dialysis, peritoneal dialysis,
         haemodialysis and transplantation).
    5. Skills in working within a structured multi-disciplinary team alongside specialist
         renal nurses, pharmacists, pharmacologists, radiologists, dieticians, social
         workers and psychologists.
    6. Working as part of an integrated clinical network and focus on transition
        services to adult care.